HIV Counseling and Testing Uptake,Knowledge and Attitude and Influencing Factors among Student Nurses and Midwives in The Gambia:An Institutional-based Cross-sectional Study

HIV counseling and testing(HCT)has become paramount in the prevention and control of HIV/AIDS worldwide.However,the uptake of HCT has been very slow globally,especially in sub-Saharan Africa.Student nurses formed the largest group undergoing health care training in the country compared to doctors and other health cadres.According to WHO,they are part of the most vulnerable group to HIV infection,judging by the fact that they interact more with patients/clients than other healthcare professionals.This study aimed to determine the prevalence of HCT uptake,knowledge,and attitude and evaluate influencing factors among student nurses and midwives in public nursing schools.An institutional-based cross-sectional study design was employed to collect data from 305 randomly selected nursing students and midwives using a validated and reliable self-administered questionnaire.Descriptive statistics(percentages,mean and standard deviation)and inferential statistics(chi square,logistics regression,one-way ANOVA and independent samples t-test)were used for data analysis using SPSS version 25.0.A p-value<0.05 was considered for statistical significance.Out of the 305 students recruited for the study,60.98%were females,with a mean age of 25.5 years old.About 58.4%of the participants had tested for HIV in the past.About 95.7%acknowledged the importance of HCT in the prevention and control of HIV/AIDS.HCT uptake among student nurses and midwives was influenced by factors ranging from an individual that are interpersonal challenges(such as concerns of friends),perceived susceptibility to the disease,lack of confidentiality,stigma and discrimination from health service providers.Therefore,these barriers can be addressed through an organized targeted health education intervention and advocacy programs across health training institutions in the Gambia and beyond.

医护-社会组织一体化模式对HIV/AIDS患者ART及自我管理能力的影响

探究接受高效抗反转录病毒治疗确诊HIV/AIDS患者接受医护-社会组织一体化模式干预价值。方法 从2022年1月至2022年12月南昌市某定点医院接受抗病毒治疗及随访管理的新确诊HIV/AIDS患者100例,50例接受传统医护合作模式对照组、50例接受医护-社会组织一体化模式观察组,两组各项临床指标差异进行分析对比(从HIV抗体初筛阳性到启动ART治疗时间、抗病毒治疗一年后HIV病毒载量的指标及病毒抑制率、抗病毒治疗一年后自我管理能力)。结果 干预后与对照组比较,观察组HIV抗体初筛阳性到启动ART治疗时间显著偏低,HIV病毒载量指标水平显著偏低,病毒抑制率显著偏高,一年后自我管理能力评分显著偏高,用药依从性显著偏高(P<0.05)。结论 接受抗病毒治疗及随访管理的确诊HIV/AIDS患者接受医护-社会组织一体化模式干预后,可显著提高患者自我管理能力。此外,还能保障高病毒抑制率,缩短患者治疗时间,提升患者用药依从性。

HIV-1耐药检测技术进展

艾滋病病毒已在全球肆虐40多年,对全球公共卫生造成极大压力,时至今日艾滋病仍然是全球公共卫生面临的一道医学难题。高效联合抗病毒疗法(HAART)是艾滋病治疗的首选方案,已为众多艾滋病患者/人类免疫缺陷病毒(HIV)感染者带来巨大福祉,并为减缓艾滋病病毒的进一步传播发挥了很大作用。但随着这一方案的全面推广与应用,HIV-1耐药性也日益突出。HIV-1耐药性是影响临床抗病毒治疗效果的主要原因之一,因此进行HIV-1耐药性检测,对抗病毒药物的优化与选择、降低传播性耐药发生与防控十分重要。HIV-1耐药检测方法众多,因应用场景不同而方法各异,本文汇总国内外众多文献资料,就HIV-1耐药检测方法进行综述。

False Positive HIV “Combo” Screening Test in a Hemodialysis Patient in Saudi Arabia: A Case Report and Review of the Literature

Introduction: HIV screening tests are routinely conducted on dialysis patients as the constant exposure of their blood during the dialysis process makes them a reasonable risk for blood-borne infections. However, in low prevalence settings, where HIV rates are <0.1% of the population, false positive results are more likely. This results in apprehension in the dialysis unit as breaches in infectious disease protocols could be presumed. This is illustrated in the case report below. Case Summary: A 62-year-old male Saudi end-stage kidney disease patient secondary to DM nephropathy began dialysis a year before presentation in a hemodialysis center in Saudi Arabia. Routine screening tests done at the start of dialysis revealed negative Hepatitis C, HIV 1 and 2 screening but a positive Hepatitis B surface antigen screen. The patient went for holiday dialysis at another facility and had a routine fourth-generation HIV test done which was positive. A confirmatory HIV PCR test was negative. Conclusion: This case highlights the need for caution in interpreting highly sensitive and specific HIV screening tests in a low-prevalence setting. Routine screening beyond the national recommendation may not be necessary in low-prevalence areas.

Multiplex Rapid Test with Acceptable Diagnosis Performance as a Solution to Increase Diagnosis of Hepatitis B and C Viruses in Pregnant Women in an Area of High Prevalence of Both Hepatitis Viruses Associated with HIV

Background and Objective: HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) are very widespread in the world, however, less than 20% of the people affected are diagnosed and treated. This study aimed to determine the prevalence of HIV, HCV and HBV co-infections in pregnant women at Bangui Community University Hospital and the cost of screening. Methods: A cross-sectional study involving consenting pregnant women who came for antenatal care was performed. HIV, HCV antibodies and HBV antigens were detected using Exacto Triplex? HIV/HCV/HBsAg rapid test, cross-validated by ELISA tests. Sociodemographic and professional data, the modes of transmission and prevention of HIV and both hepatitis viruses were collected in a standard sheet and analyzed using the Epi-Info software version 7. Results: Pregnant women aged 15 to 24 were the most affected (45.3%);high school girls (46.0%), and pregnant women living in cohabitation (65.3%) were the most represented. Twenty-five (16.7%) worked in the formal sector, 12.7% were unemployed housewives and the remainder in the informal sector. The prevalence of HIV, HBV, and HCV viruses was 11.8%, 21.9% and 22.2%, respectively. The prevalence of co-infections was 8.6% for HIV-HBV, 10.2% for HIV-HCV, 14.7% for HBV-HCV and 6.5% for HIV-HBV-HCV. All positive results and 10% of negative results by the rapid test were confirmed by ELISA tests. The serology of the three viruses costs 39,000 FCFA (60 Euros) by ELISA compared to 10,000 FCFA (15.00 Euros) with Exacto Triplex? HIV/HCV/AgHBs (BioSynex, Strasbourg, France). Conclusion: The low level of education and awareness of hepatitis are barriers to development and indicate the importance of improving the literacy rate of women in the Central African Republic (CAR). Likewise, the high prevalence of the three viruses shows the need for the urgent establishment of a national program to combat viral hepatitis in the CAR.

A Review of Index Case Testing Induced Intimate Partner Violence and Electronic Management of Information in HIV Care

Intimate Partner Violence (IPV) is a form of Gender Base Violence (GBV) where an intimate partner perpetrates violence. In the HIV care continua which has the aim of achieving epidemic control based on the goals defined by UNAIDS, 95% of people living with HIV (PLHIV) have to know their HIV status, 95% initiated ARV treatment and 95% are virally suppressed in order to achieve epidemic control. One of the evidence-based strategies used for achieving an optimal number of PLHIV who know their HIV status is the Index Case Testing Strategy (ICT). While the ICT strategy helps the achievement of epidemic control, its implementation increases the incidence of IPV among either serodiscordant or concordant couples. Tackling information about IPV is very sensitive. A review of the literature on the management of HIV patient information has shown that shifting from paper-based management of HIV patient information to computerized Electronic Medical Records (EMR) systems, using software such as OPEN MRS has significantly improved the management of HIV patient information with high-level confidentiality of patient information. The reviews showed that the EMR systems put in place to manage HIV patient information need to integrate the stages used for the management of IPV among PLHIV.

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China： a Cross-sectional Study

Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio （AOR） and 95% confidence interval （CI）. Results Among the 5,996 MSM included in the study, 2,383 （39.7%） reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income （AOR = 1.49; CI = 1.10-2.02; P = 0.010）, large number of male sex partners （≥2： AOR = 1.24; CI = 2.09-1.43; P = 0.002）, sexual activity with commercial male sex partners （〉 2： AOR = 1.94; CI = 1.34 -2.82; P = 0.001）, long-term drug use （AOR = 1.42; CI = 1.23-1.62; P 〈 0.001）, and long-term HIV voluntary counseling and testing （VCT） attendance （AOR = 3.62; CI = 3.11-4.22; P 〈 0.001） were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.

Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia

Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.Methods: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis.Results: Out of the 44 791 tuberculosis survey participants, 14 164(31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15-24 years were associated with higher refusal rates.Conclusions: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.

Development of the Guideline for HIV Testing in South Korea with Low Prevalence of HIV-1 Infection Based on the Expert Consensus

Purpose: This study was conducted to develop a guideline for HIV testing in South Korea where the HIV prevalence is very low. It is necessary to make the recommendations presented here based on the epidemiology of opportunistic infection and cancer in the community. Methods: The development of a guideline for HIV testing was conducted using literature reviews and the agreement of Korean experts for HIV patients using a two-round Delphi consensus technique. Each expert was asked to independently answer to each item related to HIV risk. Ten experts participated in the two-round survey. Results: The individual items were determined based on the following categories: high risk behavior, symptom and diseases, colo-rectal diseases, uro-genital diseases and gynecology, skin and oral diseases. The final guideline consisted of 4-scale agreement rating (strongly recommended, recommended, not routinely recommended, no recommendation for routine provision). Discussion: We have developed the guideline for HIV testing in a country where the HIV prevalence is low based on a systematic investigation and expert consensus.

Trend Analysis of HIV Testing Services in Zimbabwe, 2007-2016: A Secondary Dataset Analysis

Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.

Testing Point of Care Portable Data Capture in a Hospital HIV Transmission Prevention Programme and Experience from Computerized Patient Management in a Sub-Saharan Clinic Setting

Clinicians involved in HIV/AIDS （Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome） prevention of mother to child transmission （PMTCT） programme and research activities can benefit from the advantages that computerized systems add to medical practice even in resource constrained sub-Saharan clinic settings. Their continued use of paper based systems presents clinical data management and patient care challenges. A portable point of care data capture electronic system and a computerized clinic patient management system （CCPMS） were implemented to remedy these challenges. PMTCT report compilation was easier with the portable data collection system whose data were found to be more complete and accurate with a 0.83% error rate compared to a 4.1% error rate in the paper registers. A resounding majority of clinicians preferred using the new CCPMS with many of the view that it improved drug inventory and general clinic management with a positive effect on patient care.

Assessing the Acceptability and Willingness to Use HIV Self-Testing among Student Nurses in a Private Nursing College, Gauteng Province, South Africa

Globally, there is increasing evidence that HIV self-testing (HIVST) is commonly practiced among health care workers (HCWs). Although HIVST kits are available in South Africa, their distribution and use remain unregulated and its acceptability, undocumented. The aim of the study was to explore the acceptability of HIV self-testing among student nurses, examine their willingness to use self-testing, and evaluate their views on the implementation of a regulated HIV self-testing programme. This was a qualitative explorative study, and six focus group discussions were conducted with 67 student nurses recruited from a private nursing college, in Pretoria, South Africa. Thematic analysis and NVivo10 qualitative software were used for data analysis. The nurses perceived HIVST as an acceptable option for HIV testing and most were willing to self-test. Self-testing will provide confidential and accessible HIV testing services, reduce the stigma associated with the condition, and increase partner testing and disclosure. HIVST is more likely to be practised if self-testing kits are easily accessible and affordable, and there are strategies to educate people before the adoption of HIVST. The lack of pre- and post-test counselling, the risk of inaccurate test results, and lack of strategies for the confirmation of self-testing results were the main arguments against HIVST. The high acceptance of HIVST among nurses suggests that HIVST is a feasible option to increase the uptake of HIV-testing among HCWs. However, pre- and post-test counselling should be considered important components in the implementation of self-testing services. Educational and awareness campaigns should precede the roll-out of the self-testing programs.

HIV Self-Testing Kits Uptake in Mashonaland West Province, Zimbabwe, 2019-2020: A Secondary Data Analysis

Background: Human Immuno-Deficiency Virus Self-Testing (HIVST) is a process where an individual who wants to know their HIV status collects a specimen, performs a test and interprets the result by themselves. HIVST data from the Zimbabwe AIDS and TB Program (ATP) directorate showed that between 2019-2020, only 31% of the target HIVST kits were distributed in the country. Mashonaland West Province was one of the least performing provinces in meeting targets for HIVST kits distribution. Gaps in the implementation of the HIVST in the province ultimately affect the nationwide scaleup of targeted testing, a key enabler in achieving HIV epidemic control. We analyzed HIVST trends in Mashonaland West Province to inform HIV testing services programming. Methods: We conducted a cross-sectional study using HIVST secondary data obtained from the District Health Information Software 2 (DHIS2) electronic database. We conducted regression analysis for trends using Epi Info 7.2 and tables, bar graphs, pie charts and linear graphs were used for data presentation. Results: A total of 31,070 clients accessed HIVST kits in Mashonaland West Province from 2019-2020. A slightly higher proportion (50.4% and 51.7%) of females as compared to males accessed HIVST kits in 2019 and 2020 respectively. Overall, an increase in the trend of HIVST kits uptake was recorded (males R2 = 0.3945, p-value = 0.003 and females R2 = 0.4739, p-value = 0.001). There was generally a decline in the trend of community-based distribution of HIVST kits from the third quarter of 2019 throughout 2020 (R2 = 0.2441, p-value = 0.006). Primary distribution of HIVST kits remained the dominant method of distribution, constituting more than half of the kits distributed in both 2019 (67%) and 2020 (86%). Conclusion: Mashonaland West Province was mainly utilising facility-based distribution model for HIVST over the community-based distribution model. We recommended training more community-based distribution agents to increase community distribution of HIVST kits.

2016至2020年杭州地区无偿献血人群HIV感染状况分析

目的了解杭州地区无偿献血人群HIV感染状况,为本地区降低HIV经输血传播风险,制定有效献血者招募及艾滋病防控策略提供数据支持。方法采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)和病原体核酸检测技术(nucleic acid testing,NAT)对2016年1月至2020年12月杭州地区902847例无偿献血者标本进行抗HIV-Ⅰ/Ⅱ抗体/抗原和HIVRNA检测。抗-HIV抗体/抗原或HIVRNA反应性标本送杭州市疾病控制中心进一步采用Western blot法和NAT进行确认。结果2016年1月至2020年12月杭州地区共检测HIV确证阳性103例,阳性检出率为0.01%,其中101例ELISA和NAT筛查均为阳性反应,2例ELISA筛查为阴性反应,NAT为阳性反应。103例感染者中,以男性(91.26%,94/103)、18~35岁(69.90%,72/103)、初次献血者(68.93%,71/103)为主。2016至2020年献血者HIV阳性率呈逐年下降趋势(χ^(2)=7.181,P=0.007)。男女献血者HIV阳性率各年的差异无统计学意义(χ^(2)=10.336,P=0.350;χ^(2)=0.653,P=0.957)。各年龄组献血者HIV阳性率各年的差异无统计学意义(χ^(2)=6.378,P=0.173;χ^(2)=2.318,P=0.678;χ^(2)=5.284,P=0.259;χ^(2)=9.183,P=0.057)。结论近5年HIV感染在杭州市无偿献血人群中呈低流行水平,但仍存在感染风险,应加强在低危人群中招募献血者并且应采用先进的检测技术,选择合适的检测策略,保证血液安全。

2023年肇庆市现存HIV/AIDS患者随访检测现状统计分析

目的了解肇庆市现存艾滋病病毒感染及艾滋病(human immunodeficiency virus/acquired immune deficiency syndrome,HIV/AIDS)患者随访检测现状的流行病学特征。方法肇庆市疾病预防控制中心对肇庆市2023年1—12月现存的HIV/AIDS患者开展描述性流行病学分析,比较不同流行病学特征随访检测比例。结果截至2023年底现住址为肇庆的现存患者有1745例,男女比例为2.9∶1(1300/445);年龄以20~59岁为主,占77.0%;传播途径以异性传播为主,占73.2%;以医疗机构就诊发现为主,占57.3%。按年份统计,2021—2023年肇庆市每年现存HIV/AIDS患者随访检测比例呈逐年上升的趋势[88.3%(1402/1588)vs 89.6%(1507/1682)vs 95.7%(1670/1745)],差异有统计意义(χ^(2)=66.910,P<0.05);按现住址统计,2023年各县(市、区)现存的HIV/AIDS患者随访检测比例比较,差异有统计学意义(P<0.05);按人群特征统计,疾病名称、治疗状态随访检测比例比较,差异有统计学意义(P均<0.05)。结论2021—2023年肇庆市每年现存HIV/AIDS患者随访检测比例呈逐年上升趋势,2023年各县(市、区)随访检测比例有差异。在日后随访检测工作中针对随访检测现况的相关流行病学特征,采取各项干预措施,增加病人随访检测的依从性,能有效提高现存患者随访检测比例。

一类具有Dirichlet边界条件的年龄-空间结构HIV/AIDS传染病模型的动力学分析

为了探讨个体扩散、感染年龄和Dirichlet边界环境对HIV/AIDS时空传播动力学的影响,该文构建了一类具有齐次Dirichlet边界条件的年龄空间结构HIV/AIDS传染病动力学模型.首先,应用特征线方法,作者将模型转化为一个积分反应扩散方程模型.其次,作者给出模型基本再生数R_(0)的泛函表达式,并研究了以R_(0)为阈值的模型解的动力学行为.具体地,当R_(0)<1时,HIV/AIDS在人群中可以被消除;而当R_(0)>1时,HIV感染在人群中会持续存在.最后,在二维空间区域中作者通过数值模拟验证了文中理论结果.

液氮冷冻联合5-氨基酮戊酸光动力疗法治疗HIV合并肛周尖锐湿疣患者的人乳头瘤病毒载量分析

目的分析液氮冷冻联合5-氨基酮戊酸光动力疗法(ALA-PDT)治疗HIV合并肛周尖锐湿疣(CA)患者的人乳头瘤病毒(HPV)载量情况。方法68例HIV合并肛周CA患者随机分为两组,对照组采用液氮冷冻治疗,观察组采用液氮冷冻联合ALA-PDT治疗。比较两组的临床疗效、复发率以及治疗前后的HPV DNA载量。结果治疗3、6、12个月后,两组的HPV DNA载量均显著降低,且观察组显著低于对照组(P<0.05)。观察组的治愈率显著高于对照组,复发率显著低于对照组(P<0.05)。结论液氮冷冻联合ALA-PDT治疗HIV合并肛周CA患者可有效减少HPV DNA载量,提高疗效,降低复发率。

V-V ECMO成功救治非HIV型耶氏肺孢子虫肺炎1例

临床上较少见体外膜肺氧合(ECMO)治疗非人类免疫缺陷病毒(HIV)耶氏肺孢子虫肺炎(PJP)的报道,本研究报道1例患有急性脊髓炎的患者,因免疫功能低下出现PJP,迅速进展为急性呼吸衰竭伴严重低氧血症,启动静脉-静脉ECMO(V-V ECMO)治疗,经过V-V ECMO治疗21天后成功撤离ECMO,住院41 d存活出院。虽然ECMO在免疫功能损伤的患者治疗中充满挑战、预后差,但通过精细化管理,其在非HIV感染的PJP患者中是安全、有效的。

Pulsed Eddy Current Non-destructive Testing and Evaluation:A Review

Pulsed eddy current （PEC） non-destructive test- ing and evaluation （NDT＆E） has been around for some time and it is still attracting extensive attention from researchers around the globe, which can be witnessed through the reports reviewed in this paper. Thanks to its richness of spectral components, various applications of this technique have been proposed and reported in the lit- erature covering both structural integrity inspection and material characterization in various industrial sectors. To support its development and for better understanding of the phenomena around the transient induced eddy currents, attempts for its modelling both analytically and numeri- cally have been made by researchers around the world. This review is an attempt to capture the state-of-the-art development and applications of PEC, especially in the last 15 years and it is not intended to be exhaustive. Future challenges and opportunities for PEC NDT＆E are also presented.